April 2010


A study reported in the New England Journal of Medicine found that patients admitted to the hospital for their first heart attack had a death rate that was 5% higher if they were admitted on the weekend.

What is the problem?

It is crucial to get treatment as soon as possible when a patient is having a heart attack. On the weekends, patients were more likely to have to wait. Weekend patients were less likely to get the invasive treatments such as angioplasty and stent placement in a timely manner. Many cardiac catheterization labs work with a smaller staff on the weekends.

What is a person to do?

First of all, the best thing to do is avoid getting a heart attack by preventing it from happening. The key is to be checked by your doctor and to modify your cardiac risk factors if you have them. That includes maintaining a normal blood pressure, low cholesterol, avoiding developing diabetes by exercising and maintaining a healthy body weight, not smoking, and (if appropriate), taking a baby aspirin a day.

If you do have underlying heart disease, it is possible to find it and treat it prior to having a heart attack. It is better to have a procedure such as an angiogram or an angioplasty under a controlled, elective situation versus an emergency.

If you do develop the symptoms of a heart attack (chest pain, jaw pain, shortness of breath, overwhelming fatigue, left arm pain) chew an aspirin, and call 911. The hospitals that specialize in heart disease and have cardiac surgery are the best ones to go to. They are more likely to be equipped for emergency cardiac procedures.

The key is to get to the hospital as soon as possible. Although the study showed an increase in mortality for heart attack patients on the weekend, it doesn’t mean you should wait. Furthermore, now that the results are out, my bet is that there will be some staffing changes for the majority of the hospitals around the country!


Remember the good old days when we were much younger? At the first sign of spring we would bring out our reflectors and our baby oil mixed with iodine. Every chance we got we would be out there trying to tan. Of course, between the baby oil and reflectors, most of us fried. That along with the thinning of the ozone layer has increased the risk of skin cancers for most of us.

The deadliest form of skin cancer is melanoma. The key to melanoma is to find it early. It is possible to catch it when it is just starting to form in a pre-cancerous phase. The American Cancer Society recommends that every adult over 40 have a skin exam from top to bottom. There are now some new techniques that can help your doctor follow your moles from year to year. That new technique is called “mole mapping”.

When the doctor does an exam he or she usually will eyeball your moles and then note which ones to follow over time. Mole mapping helps them to keep a record and look more closely. Mole mapping is really a general term for several techniques.

Mole Mapping

The simplest form of mole mapping is done when the doctor marks where your moles are on a drawing in the medical chart. They can note mole color, size, shape, etc. Now that we have such great computer technology, there are new forms of digital mole mapping. Programs can look at your risk factor profile (history of sun exposure, family history, age, skin type, etc.) A doctor or specially trained nurse can take high quality digital photos with a digital camera. With the photos, there can be close-ups (not exactly what they do in the movies!); they can magnify the moles as well. The images and risk factors are sent to a dermatologist who is an expert in skin cancer and a report is generated. The mapping can be repeated every 3-6 months if there are skin lesions that are concerning. Otherwise it can be done on a regular yearly basis.

This technique is really helpful in communities who do not have a dermatologist. It is probably most effective in conjunction with a dermatologist’s exam. It is also helpful to do your own exam on the parts of your skin you can see.

What is considered a suspicious lesion?

For melanoma, the things to watch for are what are called the A, B, C, D, and E.
A- Stands for asymmetry. If you could not virtually fold the mole in half and have it match up perfectly, it is asymmetrical.
B- Is for border. A mole is of concern if the border is irregular and not smooth.
C- If a mole has different colors or is dark or blue, it is of concern.
D- If the diameter is more than 6 mm or larger than the end surface of a normal pencil eraser, it is considered to be abnormal.
E- If it is expanding or enlarging over time that is also a mole of concern.

Mole mapping can be a useful procedure to help the dermatologist. It is important to have a skin exam as well as the pictures, because the photo exam can miss lesions in the scalp and the genital areas. There is nothing that can substitute for an up close and personal exam.


A recent report has found that some drugs generally used to treat seizures may increase the risk of suicide. The drugs Neurontin, Lamictal, Trileptal, Valproic Acid and Gabitril have all been found to increase the risk of suicide usually within 14 days of taking the drugs. Although these drugs are used to prevent seizures, they are also used to treat bipolar disorder, migraine headaches, neuropathy and even restless leg syndrome.

It is important that if you or a loved one are prescribed any of these drugs that others around you or them are aware of the need for close observation early on in treatment. There are always warnings about over the counter medications and herbal medications. Sometimes patients and physicians assume that prescription medications must be safe. However, as we have seen with other drugs, that may not always be the case.

Regardless of whether drugs are prescription or over the counter, it is important that you are aware of the risks as well as the benefits.


There have been many reported health benefits that have been discovered regarding the consumption of dark chocolate. One of those benefits is lowering blood pressure. When subjects with mildly elevated blood pressure were given a 100-gram dark chocolate bar daily their blood pressure significantly lowered. When milk was added to that chocolate, there was no benefit.

In another study, researchers divided a group of 470 elderly men into groups according to how much cocoa-containing food they ate and followed them over 15 years. The men who consumed the most cocoa-containing products were half as likely to die from heart disease as those who ate the least. In addition, they were half as likely to die earlier from any cause compared to those who ate foods containing the least among of cocoa or chocolate.

Finally, a recent study has found that 85% dark chocolate can decrease liver pressures after eating a meal in those with cirrhosis of the liver. After eating, abdominal pressures rise and chocolate can reduce that pressure.

Dark chocolate contains antioxidants called flavanols. Flavanols stimulate the production of nitric oxide in the artery walls. This causes the arteries to relax and pressures to reduce. That may be the mechanism for lowering blood pressure, preventing heart disease and lowering liver pressures.

Chocolate may be the new health food, but remember it has calories. So, if you are going to eat it make sure it is the good dark chocolate and that you reduce your other calories to compensate for the addition!


A new study has found that certain occupational exposures may triple the chances of women developing postmenopausal breast cancer. Acrylic, nylon fibers and polycyclic aromatic hydrocarbons are the chemicals that appear to increase the risk. The study looked at occupational exposures. The women worked with the fibers or petrol products. The risk peaked if the exposure occurred before the age of 36. This is a time when breast tissue is still active.

The study is not definitive however adds to the suspicion that environmental and occupational exposures may play a major role in the development of breast cancer. Until more evidence is discovered, women should seriously think about their job choices and choose jobs where air quality and occupational safety is a priority.


Gonorrhea is the second most commonly reported infectious disease in the United States. Unfortunately, it has become resistant to most antibiotics. Antibiotics in the cephalosporin family are the antibiotics that have been effective. However, now there are some strains of gonorrhea that have become resistant to this group of antibiotics as well.

The age group that has more cases than any other are teen girls from ages 15 to 19. If gonorrhea is left untreated it can result in pelvic inflammatory disease, infertility and even arthritis and possible heart problems.

Since the advent of antibiotics gonorrhea has changed and developed resistance. The first drug that was tried was the class of sulfa drugs, then the penicillins and a wide variety of others. It is resistant to all but the cephalosporins now and soon we may be left with no options to treat this disease.

The key is to prevent gonorrhea in the first place. It is important that we talk to our children about the consequences of unprotected sex. Regardless of how you feel about abstinence, sexually transmitted infections and how you get them is one topic that must be discussed. Otherwise, the consequences could be deadly.


New research has found that for middle aged women to maintain their weight and not gain, they need to exercise an hour a day. I take care of many middle aged women who cannot understand why they continue to gain weight despite healthy eating and exercising two to three times a week. When I mention the need to exercise daily they groan. However, there is no easy fix for the problem. As we age our metabolism slows down. We cannot eat the same amount of calories we ate when we were younger. Life, children, jobs all make it harder to find time to exercise. That is why it is so important to incorporate exercise into our daily life. For some, cycling to work may be an option. For others, walking to work or walking from a distant parking spot may be a possibility. Women who work in a building with an elevator may want to use the stairs exclusively. The key is to look around and find a way to exercise daily. It is essential so become imaginative and just do it.


A newly released British study has found that for every women who gets unnecessary treatment as a result of something found on mammography, two women are found to have breast cancer who would not have known that they had it otherwise. The findings of this study are important considering the ongoing debate of whether women between 40 and 50 should have regular mammograms. Considering that breast cancer is generally a more aggressive disease in younger women, it is important to pay attention to these finding.

Many women do not like having mammograms. They are generally uncomfortable and the breasts are exposed to a small amount of radiation. However, in my opinion and the opinion of many experts, the risk is small compared to the benefits. In recent years, most of the breast cancers I have diagnosed in my patients have been found on mammogram. No mass was felt and the patients had no symptoms.

In addition to mammogram, I believe it is important to eat a healthy diet and remain thin, exercise regularly and drink alcohol in moderation or not at all. It is estimated that as many as 30% of breast cancer cases could be prevented if women follow these three simple behaviors.

The risk of breast cancer is one in eight over a woman’s lifetime. As we get older it is important that we do what we have to do to achieve optimal health. A healthy lifestyle and regular preventive tests and exams are not just essential but an absolute necessity.


As the importance of eating fish is stressed and many of us try to move towards being health conscious, sushi has become a favorite among many baby boomers. Isn’t it just amazing how when you finally start doing what you think is healthy, you find out that it may not be? A recent study by the Environmental and Occupational Health Sciences Institute tested tuna found in 20 restaurants in New York City and found that if you ate 6 pieces of tuna a week, you will have exceeded the acceptable limit of mercury exposure that was set by the EPA!

What is the problem with mercury? It can affect your nervous system. It can cause vision, balance, and memory problems (to name a few) not to mention what it can do to a fetus if a pregnant woman is over-exposed. I have a doctor colleague who was convinced he had multiple sclerosis. He had every test and every scan imaginable. Finally, some smart doctor checked the mercury level in his urine. It was sky high. He had mercury poisoning as a result of eating a ton of tuna to help him lose weight. Once he stopped doing that, his symptoms resolved.

What is a health-conscious person to do? I would suggest limiting the tuna to 12 oz a week. Keep eating fish, but go with the safer ones such as wild salmon, herring, sardines and you can also try shrimp.

If you like things raw, make sure you go to a reputable restaurant. If you want to play it safe, get cooked fish in your sushi rolls. There are many infections that you can get from raw fish that is contaminated (food for another article).

Eat healthy and be well!


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